Innovation in European healthcare â what can Sweden learn? - LIF

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Impact of the reform on health insurers • Health insurers now have to compete at national level • Losses in enrolment up to 25%, increases up to 30% • ‘Losers’ seem to be some of the old sickness funds • Health insurers have received instruments to contain costs: e.g. selective contracting and volume/quality/price negotiations • Problems: – scarcity of providers and regional monopolies – only 34% of hospital care (2009) was freely negotiable • Need to develop more expertise • Health insurers are now allowed to make profits 256
Impact of the reform on providers • Hospitals have both inpatient and outpatient departments as well as 24-hour emergency wards • Consolidation trend (private non-profit providers) to increase negotiation power against health insurers - mergers led to fewer hospital organizations with several locations • In 2011 there were 84 general hospitals, 8 university hospitals and 59 specialist institutions (e.g. rehabilitation centres) • Investments are included in tariffs for hospitals (2008) and long-term care institutions (2009) • For hospitals and mental care a performance-based DRG-type system (29.000 Diagnosis and Treatment Combinations - DBCs) was introduced in 2005 • In 2009 the price of 34% of all DCBs was freely negotiable between health insurers and hospitals • Reform of DBC-system started in 2012 -> reducing the number of DBCs to around 4.400 in 123 groups; new name: DOT system; 70% are now freely negotiable • For the development of the DOT system exists a special state agency (DBC-Onderhoud) • The DOT structure can be roughly divided into three categories: – 1. Intensive, surgical products – 2. Conservative inpatient care products (diagnostics and small treatment for inpatient care; no large surgery) – 3. Conservative outpatient care products (diagnostics and small treatment for outpatient care; no large surgery) • Instead of a fixed budget per year, from 2012 onwards health insurers negotiate with hospitals regarding the purchase of care and the related conditions 257
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Innovation in European healthcare -
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Introduction If it was up to the NI
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GDP per capita 2011, thUSD Annual G
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Import Technology uptake Export End
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Venture capital flight away from li
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Issues in Sweden: clinical research
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Issues in Sweden: communication and
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Issues in Sweden: reimbursement for
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Summary - the innovation challenges
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InDex Pharmaceuticals InDex Pharmac
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Addressable Patient Population in E
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What conclusions can be drawn from
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Elekta has established a model for
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The five European countries 27
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German healthcare system • German
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Role of important Government and Of
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Role of important Government and Of
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Germany needs more healthcare for t
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37 DRG was developed in the US in t
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The base rate varied during the con
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There are public, private for profi
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Financing System of the German SHI
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Central Changes in the German healt
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Innovations in the German Health Ca
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Cost of Pharmaceuticals and Medical
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Three steps for Integration of New
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NUB Process in the German DRG Syste
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Innovative drugs in the outpatient
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Implementation and use of innovativ
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Innovations in the outpatient secto
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Implementation and use of innovatio
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New possibility of testing potentia
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Structural Innovations in the Inpat
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Structural Innovations in the Outpa
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During the last ten years two centr
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France The healthcare system in Fra
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Financing of the French health care
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The French medical device industry
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The French Medical Devices Market:
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The average time necessary to get a
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Shortening the reimbursement proces
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A successful solution to provide ad
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2. Pharmaceuticals 89
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Hospitals carry out more and more o
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ATU System: Off label use Exemption
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3. Financial incentives and reimbur
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The evaluation of new products by t
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Some particularly expensive drugs a
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In hospitals, expensive and innovat
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The impact of T2A on innovation Act
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The Support for Innovative and Cost
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Financing innovation through the Pu
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8 clusters specialised in the healt
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Medical Devices’ Patenting: less
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The example of the SAAT Conectus Al
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The UK The healthcare in the UK is
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The NHS is underpinned by a set of
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Today the PCTs are the main purchas
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Prior to the Health and Social Care
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Primary Care Trusts (PCTs) have pla
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The new national level bodies overs
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The NHS, must deliver efficiency sa
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PbR was first introduced in 2005/06
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The design of HRG4 reflects a signi
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PbR is being incrementally reformed
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NHS-funded primary care is provided
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The Quality of Outcomes Framework (
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The Health and Social Care Act (201
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The United Kingdom is a major produ
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£m Healthcare industries are clust
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Several bodies aim to improve the k
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National Institute for Health and C
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Overview of key NICE assessment pro
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NHS National Technology Adoption Ce
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“Innovation” has central place
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Bodies to support innovation in hea
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The UK is a world-leader in life-sc
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There still exists large regional v
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UK rankings and usage as a percenta
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Multiple structural layers within N
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NHS lacks control mechanism for imp
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Short-term budget-cycles often are
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Actions described by respondents du
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Actions described by respondents du
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Actions deriving from the review
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The following measures were suggest
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The planned compliance regime is ge
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Actions to incentivise innovation t
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NICE’s HTA process: NICE’s stan
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The implementation of NICE guidelin
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Implementation: A recommended proce
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The NHS Technology Adoption Centre
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The Government has invested a recor
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The Government’s funding has also
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Case 2: AstraZeneca and NIHR Cancer
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The NIHR has also established Healt
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As part of the Government’s Life
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All applications for the Biomedical
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NOCRI has worked together with MRC
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Academic Health Science Centres (AH
Page 205 and 206: What can Sweden learn from the UK?
Page 207 and 208: Facts - the proportions of Danish h
Page 209 and 210: The Danish healthcare system is pri
Page 211 and 212: Public-private investments in R & D
Page 213 and 214: The Danish healthcare industry is a
Page 215 and 216: Public investments in the future st
Page 217 and 218: The public renewal fund is meant to
Page 219 and 220: With the responsibility for adminis
Page 221 and 222: Organisational chart - the capital
Page 223 and 224: The Innovation environments invest
Page 225 and 226: Overall the innovation environments
Page 227 and 228: Sara established a successful busin
Page 229 and 230: Infrastructure for Innovation - The
Page 231 and 232: The networks consist of 22 innovati
Page 233 and 234: The overall Danish Innovation infra
Page 235 and 236: The new market maturing-fund will h
Page 237 and 238: The new Danish Innovation strategy
Page 239 and 240: Subsidy for new outpatient medicame
Page 241 and 242: The evaluation and assessment of ne
Page 243 and 244: Cost reduction in expensive hospita
Page 245 and 246: The public procurement of Medtech -
Page 247 and 248: Innovative public procurement of Me
Page 249 and 250: What can Sweden learn from Denmark?
Page 251 and 252: The Netherlands are spending more o
Page 253 and 254: Health insurers are allowed to make
Page 255: Financial flows in the Dutch health
Page 259 and 260: Impact of the reform on patients/in
Page 261 and 262: Impact of the reform The Dutch heal
Page 263 and 264: Innovations in the Dutch healthcare
Page 265 and 266: The reimbursement system should all
Page 277 and 278: Summary and conclusions 277
Page 279 and 280: There is a correlation between a co
Page 281 and 282: Conclusions - what can Sweden learn
Page 283 and 284: Two general recommendations and one
Page 285: www.vascoadvisers.com Supported by
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Innovation in European healthcare â what can Sweden learn? - LIF

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